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Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery. Healthcare (Basel) 2022; 10:healthcare10020313. [PMID: 35206928 PMCID: PMC8872222 DOI: 10.3390/healthcare10020313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. Methods: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. Results: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). Conclusions: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.
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Min JY, Lee JR, Kang YS, Ho JH, Byon HJ. Pediatric characteristics and the dose of propofol for sedation during radiological examinations: a retrospective analysis. J Int Med Res 2021; 49:300060521990992. [PMID: 33641471 PMCID: PMC7923994 DOI: 10.1177/0300060521990992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The present study aimed to investigate patients' characteristics that can affect the dose of propofol required to sedate children undergoing imaging. METHODS In this retrospective, observational study, we reviewed medical records of children aged 0 to 18 years who were classified as having American Society of Anesthesiologists status 1 or 2 and they underwent imaging under propofol sedation between January 2011 and August 2016. Collected data included patients' demographics, propofol doses, duration of sedation, and complications. Regression analysis was performed to determine patients' characteristics that may affect the dose of propofol required to induce sedation. RESULTS A total of 925 patients were included. Simple linear regression showed that the dose of propofol was correlated with age, height, weight, and body surface area. Using the results of multiple linear regression, the following formula was used to estimate the dose of propofol (mg) for sedation: 0.75 + 0.14 × age (months) + 45.82 × body surface area (m2). CONCLUSION A child's age, height, and body surface area should be considered when deciding the induction dose of propofol. Additionally, the formula that we have proposed can be used to estimate the dose of propofol required to induce sedation in children undergoing imaging.
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Affiliation(s)
- Ji Young Min
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yhen Seoung Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, National Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Jung Hwan Ho
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, National Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Hyo Jin Byon
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Wu M, Yin X, Chen M, Liu Y, Zhang X, Li T, Long Y, Wu X, Pu L, Zhang M, Hu Z, Ye L. Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning. BMC Neurol 2020; 20:394. [PMID: 33121474 PMCID: PMC7596952 DOI: 10.1186/s12883-020-01972-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery. METHODS A total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5-1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation. RESULTS At the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4-5 points, 51.54% vs. 32.64%; 1-3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups. CONCLUSIONS Propofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis. The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).
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Affiliation(s)
- Menghang Wu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Xiaorong Yin
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Maojun Chen
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Yan Liu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Xia Zhang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Tingting Li
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Yujuan Long
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Xiaomei Wu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Lihui Pu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Maojie Zhang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Zhi Hu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China.
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Rashed A, Mazer-Amirshahi M, Pourmand A. Current Approach to Undifferentiated Headache Management in the Emergency Department. Curr Pain Headache Rep 2019; 23:26. [PMID: 30868276 DOI: 10.1007/s11916-019-0765-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To discuss pharmacological interventions in the emergency department (ED) setting for the management of acute primary headache. RECENT FINDINGS Acute headache treatment in the ED has seen an expansion in terms of possible pharmacological interventions in recent years. After a thorough evaluation ruling out dangerous causes of headache, providers should take the patient's history, comorbidities, and prior therapy into consideration. Antidopaminergics have an established role in the management of acute, severe, headache with manageable side-effect profiles. However, recent studies suggest anesthetic and anti-epileptic drugs may play roles in headache treatment in the ED. Current literature also suggest steroids as a promising tool for emergency department clinicians combating the readmission of patients with recurrent headaches. Emergency medicine providers must be cognizant of these traditional and emerging therapies in order to optimize the care of headache patients.
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Affiliation(s)
- Amir Rashed
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA.,School of Medicine, Georgetown University, Washington, DC, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA.
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Aminiahidashti H, Shafiee S, Hosseininejad SM, Firouzian A, Barzegarnejad A, Kiasari AZ, Kerigh BF, Bozorgi F, Shafizad M, Geraeeli A. Propofol–fentanyl versus propofol–ketamine for procedural sedation and analgesia in patients with trauma. Am J Emerg Med 2018; 36:1766-1770. [DOI: 10.1016/j.ajem.2018.01.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 01/25/2023] Open
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Mohr NM, Stoltze A, Ahmed A, Kiscaden E, Shane D. Using continuous quantitative capnography for emergency department procedural sedation: a systematic review and cost-effectiveness analysis. Intern Emerg Med 2018; 13:75-85. [PMID: 28032265 DOI: 10.1007/s11739-016-1587-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
End-tidal CO2 has been advocated to improve safety of emergency department (ED) procedural sedation by decreasing hypoxia and catastrophic outcomes. This study aimed to estimate the cost-effectiveness of routine use of continuous waveform quantitative end-tidal CO2 monitoring for ED procedural sedation in prevention of catastrophic events. Markov modeling was used to perform cost-effectiveness analysis to estimate societal costs per prevented catastrophic event (death or hypoxic brain injury) during routine ED procedural sedation. Estimates for efficacy of capnography and safety of sedation were derived from the literature. This model was then applied to all procedural sedations performed in US EDs with assumptions selected to maximize efficacy and minimize cost of implementation. Assuming that capnography decreases the catastrophic adverse event rate by 40.7% (proportional to efficacy in preventing hypoxia), routine use of capnography would decrease the 5-year estimated catastrophic event rate in all US EDs from 15.5 events to 9.2 events (difference 6.3 prevented events per 5 years). Over a 5-year period, implementing routine end-tidal CO2 monitoring would cost an estimated $2,830,326 per prevented catastrophic event, which translates into $114,007 per quality-adjusted life-year. Sensitivity analyses suggest that reasonable assumptions continue to estimate high costs of prevented catastrophic events. Continuous waveform quantitative end-tidal CO2 monitoring is a very costly strategy to prevent catastrophic complications of procedural sedation when applied routinely in ED procedural sedations.
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Affiliation(s)
- Nicholas Matthew Mohr
- Department of Emergency Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA.
- Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA.
| | - Andrew Stoltze
- Department of Emergency Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Elizabeth Kiscaden
- Hardin Library for the Health Sciences, University of Iowa, 600 Newton Road, Iowa City, IA, 52242, USA
| | - Dan Shane
- Department of Health Management and Policy, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52246, USA
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Hartling L, Milne A, Foisy M, Lang ES, Sinclair D, Klassen TP, Evered L. What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews. Acad Emerg Med 2016; 23:519-30. [PMID: 26858095 PMCID: PMC5021163 DOI: 10.1111/acem.12938] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sedation is increasingly used to facilitate procedures on children in emergency departments (EDs). This overview of systematic reviews (SRs) examines the safety and efficacy of sedative agents commonly used for procedural sedation in children in the ED or similar settings. METHODS We followed standard SR methods: comprehensive search; dual study selection, quality assessment, data extraction. We included SRs of children (1 month to 18 years) where the indication for sedation was procedure-related and performed in the ED. RESULTS Fourteen SRs were included (210 primary studies). The most data were available for propofol (six reviews/50,472 sedations) followed by ketamine (7/8,238), nitrous oxide (5/8,220), and midazolam (4/4,978). Inconsistent conclusions for propofol were reported across six reviews. Half concluded that propofol was sufficiently safe; three reviews noted a higher occurrence of adverse events, particularly respiratory depression (upper estimate 1.1%; 5.4% for hypotension requiring intervention). Efficacy of propofol was considered in four reviews and found adequate in three. Five reviews found ketamine to be efficacious and seven reviews showed it to be safe. All five reviews of nitrous oxide concluded it is safe (0.1% incidence of respiratory events); most found it effective in cooperative children. Four reviews of midazolam made varying recommendations. To be effective, midazolam should be combined with another agent that increases the risk of adverse events (upper estimate 9.1% for desaturation, 0.1% for hypotension requiring intervention). CONCLUSIONS This comprehensive examination of an extensive body of literature shows consistent safety and efficacy for nitrous oxide and ketamine, with very rare significant adverse events for propofol. There was considerable heterogeneity in outcomes and reporting across studies and previous reviews. Standardized outcome sets and reporting should be encouraged to facilitate evidence-based recommendations for care.
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Affiliation(s)
- Lisa Hartling
- Alberta Research Centre for Health EvidenceDepartment of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Andrea Milne
- Alberta Research Centre for Health EvidenceDepartment of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Michelle Foisy
- Alberta Research Centre for Health EvidenceDepartment of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Eddy S. Lang
- Department of Emergency MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Douglas Sinclair
- Department of Emergency MedicineSt. Michaels HospitalUniversity of TorontoTorontoOntarioCanada
| | - Terry P. Klassen
- Department of PediatricsUniversity of Manitoba and Child Health Research Institute of ManitobaWinnipegManitobaCanada
| | - Lisa Evered
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
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